Submacular Hemorrhage and CNVM - 20 year old Chinese Myope
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20-year-old man was seen in the office on May 11, 2011. He noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. You saw a macular hemorrhage and suggest he come here for an evaluation.
VISUAL ACUITY: OD 20/400, OS 20/40. IOP: OD 17, OS 12.
SLIT EXAMINATION: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is pigment epithelium thickening nasal to the fovea with a small, less than a disc area of submacular hemorrhage and 1+ subretinal fluid.
OS: Vertical C/D ratio is 0.1. The macula looks normal. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence nasal to the fovea, which increases in the late frames suggesting at least a pigment epithelial detachment and probably choroidal neovascular membrane. There is hyperfluorescence centrally where the hemorrhage is. The left eye was angiographically normal.
IMPRESSION:
1. MYOPIC MACULAR DEGENERATION – RIGHT EYE
2. MACULAR HEMORRHAGE – RIGHT EYE
3. WET MACULAR DEGENERATION – RIGHT EYE
DISCUSSION: I explained to the patient there is bleeding in the right macula, which will hopefully resolve on its own. To reduce the risk of rebleeding and also to help resolve the subretinal choroidal neovascular membrane, I suggested treatment with Lucentis. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated the right eye with intravitreal injection of Lucentis (0.5 mg/0.05 ml) without any difficulty today. I asked him to return for a check in one month.
There is a recent paper suggesting that one treatment is sufficient in many high myopes and I am hopeful that he won’t need tests or further therapy. I asked him to return for a check urgently should he notice a problem and he will see you back regularly. I warned him if his vision does recover, it will be slow and there is probably about a 50/50 chance his vision will improve over the next three to six months. Thank you for allowing me to participate in his care.
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old503 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old532 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
(0 votes)
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old464 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
(0 votes)
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old405 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
(0 votes)
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old477 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
(0 votes)
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old423 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
(0 votes)
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old505 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
(0 votes)
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Macular Hemorrahge and Probable CNVM Right eye for 2 weeks VA 20/400 - 20 Year old471 views20-year-old man noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. VISUAL ACUITY: OD 20/400
(0 votes)
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20-year-old man was seen in the office on May 11, 2011. He noticed vision loss in the right eye about two weeks ago and if anything it seems to be getting worse. He is a high myope. You saw a macular hemorrhage and suggest he come here for an evaluation.
VISUAL ACUITY: OD 20/400, OS 20/40. IOP: OD 17, OS 12.
SLIT EXAMINATION: Normal with clear lenses.
EXTENDED OPHTHALMOSCOPY:
OD: Vertical C/D ratio is 0.1. There is pigment epithelium thickening nasal to the fovea with a small, less than a disc area of submacular hemorrhage and 1+ subretinal fluid.
OS: Vertical C/D ratio is 0.1. The macula looks normal. Photos confirm clinical findings.
FLUORESCEIN ANGIOGRAPHY: Fluorescein angiography shows hyperfluorescence nasal to the fovea, which increases in the late frames suggesting at least a pigment epithelial detachment and probably choroidal neovascular membrane. There is hyperfluorescence centrally where the hemorrhage is. The left eye was angiographically normal.
IMPRESSION:
1. MYOPIC MACULAR DEGENERATION – RIGHT EYE
2. MACULAR HEMORRHAGE – RIGHT EYE
3. WET MACULAR DEGENERATION – RIGHT EYE
DISCUSSION: I explained to the patient there is bleeding in the right macula, which will hopefully resolve on its own. To reduce the risk of rebleeding and also to help resolve the subretinal choroidal neovascular membrane, I suggested treatment with Lucentis. The office visit included a 15-minute counseling session during which I reviewed the alternatives, risks, benefits and limitations of various treatment options. I treated the right eye with intravitreal injection of Lucentis (0.5 mg/0.05 ml) without any difficulty today. I asked him to return for a check in one month.
There is a recent paper suggesting that one treatment is sufficient in many high myopes and I am hopeful that he won’t need tests or further therapy. I asked him to return for a check urgently should he notice a problem and he will see you back regularly. I warned him if his vision does recover, it will be slow and there is probably about a 50/50 chance his vision will improve over the next three to six months. Thank you for allowing me to participate in his care.
